Provider Demographics
NPI:1235136565
Name:CARTER, CHARLES BENJAMIN JR (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:BENJAMIN
Last Name:CARTER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6622 N 91ST AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2569
Mailing Address - Country:US
Mailing Address - Phone:602-759-6883
Mailing Address - Fax:602-224-3315
Practice Address - Street 1:4511 N CAMPBELL AVE STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6424
Practice Address - Country:US
Practice Address - Phone:520-529-6500
Practice Address - Fax:520-209-7337
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ62734207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200199750AMedicaid
AZ090305Medicaid
IN000000083037OtherANTHEM NUMBER
ING96813Medicare UPIN